The infant mortality rate in the United States has undergone dramatic decreases in the past two decades, declining by 40% since 1980. Despite these tremendous gains in infant survival, large racial disparities exist, particularly between black and white infants. The black infant mortality rate is 2.4 times as high as that of white. This large racial disparity is a major public policy concern and has led the President to identify infant mortality as one of six areas to be targeted i order to reduce racial disparities in health in the United States. In this project, we focus on racial and ethnic differences in access to care among high-risk infants. Specifically, we will address the following questions: What is the extent of racial and ethnic differences in access to high quality and high-level NICU services? Which factors are mutable and thus amenable to policy interventions that could reduce the racial gap in infant mortality in the United States? The project will use linked birth, records, death records and hospital discharge abstract data for all births in the state of California for the years 1999-2000. The provision of NICU care has undergone large changes in recent years, with a shift away from the regionalization of services in high-level NICUs to the provision of care in an ever-increasing number of lower-level NICUs, with largely unknown consequences of the quality of patient care. California has been at the forefront of this provider shift, as well as to the large shift in the receipt of health insurance coverage through managed care plans. The state is ethnically diverse, with the largest number of Hispanic and Asian births and ranking fifth in the number of black births, thus providing a fertile ground for studying the proposed relationships.